Topography of Cross-sectional and Longitudinal Glucose Metabolic Deficits in Alzheimer's Disease: Pathophysiologic Implications

doi:10.1001/archneur.1992.00530350056020

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Vol. 49 No. 11, November 1992

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Topography of Cross-sectional and Longitudinal Glucose Metabolic Deficits in Alzheimer's Disease

Pathophysiologic Implications

Gwenn S. Smith, PhD; Mony J. de Leon, EdD; Ajax E. George, MD; Alan Kluger, PhD; Nora D. Volkow, MD; Thomas McRae, MD; James Golomb, MD; Steven H. Ferris, PhD; Barry Reisberg, PhD; Joseph Ciaravino; Mary Ellen La Regina

Arch Neurol. 1992;49(11):1142-1150.

Abstract

• Positron emission tomographic studies of cerebral glucosemetabolism have shown high diagnostic specificity in distinguishingamong the degenerative dementias and differentiating betweenAlzheimer's disease (AD) and normal aging. The current investigationwas undertaken to characterize the regional glucose metabolicdeficits in AD, using cross-sectional and longitudinal studydesigns. All subjects met the National Institute of Neurologicaland Communicative Disorders and Stroke—Alzheimer's Diseaseand Related Disorders Association criteria for AD (n=45) orwere normal (n=20), and the AD subjects were subdivided intoincipient and mild AD and moderate plus moderately severe subgroupsbased on the Global Deterioration Scale. The subjects underwenta non—contrast computed tomographic scan and a positronemission tomographic (PETT VI) scan. The AD subjects (n=14)and normal control subjects (n=15) received evaluations 2 to3 years after baseline study. The brain regions that show glucosemetabolic deficits cross-sectionally (temporal and parietalassociation areas, with lesser degrees of deficit in subcorticalgray matter structures), over the stages of AD, also show furtherdeficits longitudinally within the same AD subjects. The reductionin glucose metabolism is greater than would be expected fromthe degree of brain atrophy. The glucose metabolic deficitsare discussed in the context of neuropathologic findings andneurotransmitter deficits in AD.

Author Affiliations

From the Departments of Psychiatry (Dr Smith), Aging and Dementia Research Center (Drs de Leon, Kluger, Golomb, Ferris, Reisberg, Ciaravino, and La Regina), Radiology, Division of Neuroradiology (Dr George), Medicine, Division of Geriatrics (Dr McRae), and Neurology (Dr Golomb), New York (NY) University School of Medicine; and Department of Medicine, Brookhaven National Laboratory, Upton, NY (Dr Volkow).

Footnotes

Accepted for publication May 12, 1992.

Reprint requests to Department of Psychiatry, New York UniversitySchool of Medicine, New Bellevue 12 WZ3, 550 First Ave, NewYork, NY 10016 (Dr Smith).

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